Deciding if Hormone Replacement Therapy is Right For You
By Dr E on July 11, 2014
Why do so many doctors or doctor’s wives take Hormone Replacement Therapy (HRT)? Because a body of scientific evidence supports its safety and health benefits.
Research on Hormone Replacement Therapy
In 2013, a Global Medical Consensus on Menopausal Hormone Replacement Therapy was published—this study contained medical recommendations that all member groups from around the world agreed to.
Informed advice from your Physician should, at the VERY least, agree with these minimal practice guidelines. As you decide on whether HRT is right for you, I hope you’ll look at these global meta-analysis (not single-study) findings:
- HRT is the most effective treatment for body changes such as hot flashes and night sweats and the benefit of its use outweighs risk for women under 60 or within 10 years from menopause.
- HRT is effective to prevent osteoporosis-related fractures in at-risk women before 60 or within 10 years from menopause.
- Estrogen-alone HRT decreases coronary heart disease and all causes of mortalityin women younger than 60 or within 10 years of menopause. Adding progesterone has not been found to cause an increase or decrease in heart disease from non-treated women.
- Local low dose estrogen intra-vaginally is the most effective intervention for treatingvaginal dryness or intercourse discomfort.
- Estrogen is appropriate in women after hysterectomy, but progesterone is required in the presence of a uterus.
- The risk of stroke and venous thromboembolism increases with oral HRT, but absolute risk is rare before 60. This risk of stroke is lower with the low dose estrogen patch.
- Risk of breast cancer in women over 50 on HRT is complex but absolute risk is small. Increased risk may be associated with progesterone addition.
- The type and duration of HRT should be consistent with treatment goals and individualized for each patient.
- In women with premature ovarian insufficiency (including surgical menopause), HRT should be used at least until the age of average menopause (mid 50s).
- HRT use in breast cancer survivors is not recommended at this time.
Estrogen HRT for Women, At What Age?
Overall, estrogen HRT makes sense for women starting before age 60, with fewer heart attacks, less death and even less breast cancer resulting.
In most women, HRT actually decreases coronary heart disease and overall mortality as compared to women who do not use HRT. Even for populations at high risk of breast cancer, the risk is a 1% absolute lifetime increased risk, which is no more than that found with being overweight or never having had children (4% increase).
In providing you with what I consider the best information from both a professional and personal viewpoint, I am well aware that you will hear conflicting views. The FDA and the NIH recommendations in their March 2014 menopause “Fact” sheet stated: “Hormones should be used at the lowest dose that helps and for the shortest time.” However, as the major medical menopause groups shockingly note, there is no science anywhere that supports such a “politically correct” recommendation!
My Experience with Menopause and HRT
From a functional standpoint, since starting HRT, I have not had the panic attacks or agoraphobia I used to have. I can actually tell, internally (as can many women) when I am due for my testosterone shot: I start to get a little anxious again.
Personally, I look with gratitude that I had a very sharp ObGyn who got me on the right hormones right away (a Vivelle estrogen patch, Vagi-fem vaginal tablets and an IM testosterone injection every 6 weeks).
Menopause hits many women hard the way it hit me—and stress only makes this worse.
But remember that all this “craziness” is mainly due to biochemical shortages of the sex steroids, like estrogen, that our bodies make when we are in our reproductive years.
Once our reproductive capacity is over, these sex steroid changes wreak havoc in our bodies and brains even though we still have HALF of our lives to live. Most of our ancestresses did not live past their forties. Our modern generations of women are living anew phase in human sexual evolution, one woman at a time.
Just to be clear, I am not compensated in any way for my views on hormone replacement. These are my personal thoughts on the subject.
- Dr. E
Science can help us nurture and enjoy our sexual selves.